The Swedish Version of the eHealth Literacy Questionnaire: Translation, Cultural Adaptation, and Validation Study

Abstract

Background With the increasing digitalization in health care, an effective instrument is necessary to assess health care consumers’ digital competencies—their “eHealth literacy.” The 7-scale eHealth Literacy Questionnaire (eHLQ), based on the theoretically robust eHealth Literacy Framework, has shown strong psychometric properties in Denmark and Australia. Objective The aim of this study was to translate, culturally adapt, and evaluate the psychometric properties of the Swedish version of the eHLQ. Methods We followed the Translation Integrity Procedure guidelines to translate and culturally adapt the questionnaire to Swedish using forward and backward translations, review by an expert panel, and cognitive interviewing. The psychometric properties of the Swedish eHLQ were investigated by evaluating its internal consistency (Cronbach α) and a priori–defined factor structure (confirmatory factor analysis). Results A total of 236 primary health care patients and parents of hospitalized children were included in the validation analysis. The mean age was 48.5 years, and 129 (55%) were women. All 7 eHLQ scales showed good internal consistency, with the Cronbach α ranging from .82 to .92. Single-factor and 7-factor confirmatory factor analysis showed satisfactory model-fit values. With one exception, all items demonstrated satisfactory loadings on their respective factors. Conclusions The Swedish eHLQ demonstrated strong psychometric properties. It has the potential as a useful tool for a variety of purposes, including population surveys, intervention evaluations, and eHealth service implementations.

Spanish and Catalan Versions of the eHealth Literacy Questionnaire: Translation, Cross-Cultural Adaptation, and Validation Study

“…Results for both the Spanish and Catalan versions showed means around 2.5 points, with the 7 scales showing a similar deviation pattern. The values were in a similar range to that of the values obtained in the studies in Denmark (between 2.42 and 2.97) [22], Sweden (between 2.58 and 3.04) [25], and Taiwan (between 2.37 and 3.08). In all 3 cases, scale 2 (Understanding of health concepts and language) had the highest score, and scales 7 (Digital services that suit individual needs; for the Danish and Swedish versions) and 6 (Access to digital services that work; for the Mandarin version) had the lowest mean.…”

“…In both studies, the lowest internal consistency values were also found for scale 2. Although the Swedish version [25] shows higher values (ranging from 0.82 to 0.92), scale 2 (together with scale 6) also shows the lowest internal consistency values.…”

“…The eHLQ was constructed simultaneously in Danish and English to minimize cultural references [22]. It has shown good internal consistency reliability, and beyond these 2 original versions, as far as the authors of this study are aware, there are 3 more published versions available today that have shown positive evidence of psychometric quality ( [24] in Mandarin [25], Swedish [26], and Dutch), although other adaptations are in progress across Europe. The eHLQ has been used to assess health literacy in different groups [27][28][29] both in Denmark and Australia [27,30], and further extensions of it have been developed for application in specific groups, for example, for health professionals [31] or older people, to assess their readiness to use digital health services [32].…”

eHealth literacy and health-related Internet use among Swedish primary healthcare visitors: Cross-sectional questionnaire study (Preprint)

“…The eHLQ was initially developed simultaneously in Danish and English, demonstrating strong psychometric properties in various contexts [22,32,33]. For the Swedish translation, a systematic and rigorous process of translation and cultural adaptation was employed, resulting in the validation of solid psychometric properties specific to the Swedish version [34]. In addition to the eHLQ, two additional items were included to assess participants' perceptions of the usefulness and importance of HRII, using a five-point Likert scale.…”